Although the Kistner tracheostomy tube was introduced 20 years ago, it has never been formally evaluated. This tube is an appliance used to maintain a tracheostomy stoma when there is some doubt as to the patient's ability to maintain his airway without a tracheostomy tube. The Kistner tube is a short tube that occupies only the distance from the skin to the inside of the tracheal wall. A one-way valve allows air to be taken in through the tube on inhalation, but closes on expiration, forcing the air to exit through the larynx. This allows the patient to build up sufficient intrathoracic pressure to produce effective coughing and enjoy a normal phonatory function. During a 5-year period, Kistner tubes were used in 105 patients in this institution. Only 2 patients could not tolerate the tube and required change to a regular tracheostomy tube. Complications related to the Kistner tube consisted of valve malfunction in 35 patients, local skin infection in 20 patients, dislodgment of the tube in 5 patients, and partial (in 5 patients) and complete (in 1 patient) upper airway obstruction. Proper placement of the tube is of outstanding importance to prevent protrusion of the tube into the tracheal lumen causing obstruction of the airway. Recommended maneuvers for prevention of complications along with advantages and shortcomings of the tube are discussed. With proper selection of the patient, use of the Kistner tracheostomy tube provides a safe and effective method to remove retained secretions and to wean from tracheostomy.